Quike & Vivi's World

Men Syndromes

2012-02-16T10:52:00.001-05:00

Multiple Endocrine Neoplasia Syndromes

•MEN 2A→ Mutation of germline RET ( neural crest cells)

Quike & Vivi's World

2012-01-30T11:58:00.000-05:00

2012-01-29T17:05:00.000-05:00

Patient has facial angiofibroma, ash-leaf spots of skin depigmentation, hx of seizures, and mental retardation.

What condition does this patient have?

What neoplasms is this patient at risk of developing?

→•Tuberous Sclerosis

→•Cardiac rhabdomyoma
•Astrocytoma
•Angiomyolipoma

Watch live video from Chepetico on www.justin.tv

2012-01-29T17:00:00.000-05:00

Encapsulated bacteria

Mnemonic:
Some Killers Have Pretty Nice Capsules

Streptococcus (Group B agalactiae) (S. Pneumoniae), Salmonella,
Klebsiella
Hemophilus influenza
Proteus
Neisseria meningitidis

Cryptococcus (fungus)

2012-01-29T16:22:00.000-05:00

What organisms do not take gram stain?

Rickettsia
Chlamydia
Legionella
Mycobacterium
Mycoplasm

Cranial Nerves

2012-01-28T11:24:00.001-05:00

Sensitive: I, II, VIII
Motor: III, IV, VI, XI, XII
Mixed: V, VII, IX, X
Corticobulbar: V, VII, X, XI, XII

All CN nuclei receive double innervation (from both sides of cortex) → a lesion of tracts innervating CN nuclei won't result in any physical manifestation except CN VII (Nucleus has Upper & lower divisions) & some individuals CN XII (mainly contralateral bulbar innervatoin)

2012-01-27T23:23:00.001-05:00

Aminoaciduria
FANCONI SYNDROME	HARTNUP DISEASE
Generalized aminoaciduria Including: ARGININE, PROLINE, HYDROXYPROLINE	Only *neutral* AA in urine NO: Arginine, Proline, Hydroxyproline
	Alanine, Serine, Threonine, Tyrosine, Tryptophan, Histidine, Valine, Leucine, Isoleucine, Phenylalanine
Proximal Renal Tubular: · Acidosis (loss of bicarbonate in Urine) · Aminoaciduria · Phosphaturia · Glucosuria	· Aminoaciduria · Renal & Intestinal Tryptophan absorption defect · Pelagra like + ATAXIA + Photosensibilidad (Dermatitis, Diarrhea, Dementia)

2012-01-27T23:11:00.000-05:00

Cystic Tumor in the Cerebellum of a child:

Most likely:

Pilocytic Astrocytoma #1 MCC Tumor in children

BX Well differenciated neoplasm composed of SPINDLE CELLS with hair-like glial processes a/w microcysts
Cells mixed with Rosenthal fibers & granular eosinophilic bodies

2012-01-27T23:01:00.002-05:00

Primary biliar Cirrhosis

Antimitochondrial Abs
Pruritus, fatigue. pale stool & Xantema
Bx: Lumphocyte infiltration, granulomatous destruction on interlobular bile ductus

2012-01-27T22:51:00.000-05:00

Triad: Confusion, Ataxia Ophthalmoplegia

Seen in:

Chronic alcoholism ((horizontal nistagmus, bilateral abducens palsy. Bilateral mamillary bodies lesion)
Severe malnutrition

2012-01-27T16:17:00.001-05:00

DISEASE
Phenylketonuria

Alkaptonuria

Maple Syrup Urine Disease

Homocysteinuria

ENZIME DEFICIENT
Phenylalanine Hydroxylase
(Cofactor: Tetrahydrobiopterin)

Homogentisate Oxidase

Branched -Chain Ketoacid DHase
(=α-Ketoacid DHase)(TLCFN)

Cystathionine Synthase (B6)
Homocysteine Methyl Trasferase Methyl THF

Tx/SUPLEMENT
Tyrosine

Thiamine

Cisteine

AVOID
Phenylalanine, Aspartate

Phenylalanine, Tyrosine

Leucine
Valine
Isoleucine

Neurotransmitter changes

2012-01-21T21:52:00.001-05:00

Anxiety:	↑NE, ↓GABA, ↓Serotonin (5-HT)
Depression:	↓NE, ↓Serotonin (5-HT), ↓Dopamine
Alzheimer's dementia:	↓ Ach
Huntington's disease:	↓GABA, ↓Ach
Schizophrenia:	↑Dopamine.
Parkinson's disease:	↓Dopamine, ↑Ach, ↑Serotonin (5-HT)

2012-01-02T21:52:00.001-05:00

Apoyemos a Sisi y Tzuhsi

2011-12-22T11:40:00.000-05:00

GANADORAS DEL CONCURSO "HOLIDAY TREAT CONTESTANTS: THE CUTEST PET" CON UN 76.97% DE LOS VOTOS!!!

Gracias por votar por Sisi y Tzuhsi en el concurso the cutest pet 2011

Gram + Algorithm

2011-12-20T18:33:00.001-05:00

Source FA (adapted)

No me doy por vencido en la voz de su autora CLAUDIA BRANT

2011-12-10T16:30:00.001-05:00

2011-12-09T14:01:00.000-05:00

Clinical and laboratory Findings in Vitamin B12 and Folate deficiencies

2011-11-19T03:31:00.000-05:00

Clinical and laboratory Findings in Vitamin B12 and Folate deficiencies

LABORATORY / CLINICAL FINDING	PERNICIOUS ANEMIA	OTHER Vit B12 DEFICIENCIES	FOLATE DEFICIENCY
Achlorhydria	Present	Absent	Absent
Autoantibodies	Present	Absent	Absent
Chronic athrophic gastritis	Present	Absent	Absent
Gastric carcinoma risk	↑	None	None
Hypersegmented neutrophils	Present	Present	Present
Mean corpuscular volume	↑	↑	↑
Neurologic disease	Present	Present	None
Pancytopenia	Present	Present	Present
Plasma homocysteine	↑	↑	↑
Serum gastrin level	↑	Normal	Normal
Urine methylmalonic acid	↑	↑	Normal

Viruses

2011-11-09T02:02:00.000-05:00

Lysosomal storage diseases

2011-11-06T01:43:00.004-04:00

2011-10-30T22:23:00.002-04:00

Cytocrome P450

2011-10-24T23:28:00.002-04:00

	INDUCERS	INHIBITORS
Effect on drugs	Decreased (fail to respond)	Increased (risk of toxicity)
Anticonvulsivants	Barbiturates (Phenobarbital) Phenytoin Carbamazepine Ethosuximide	Valproic Acid
Antibiotics	Rifampin	Chloramphenicol Quinolones (Ciprofloxacin) Macrolides (Erythromycin) Sulfonamides (TMT SMX) Isoniazid (INH)
Antifungals	Griseofulvin	Ketoconazole Fluconazole
Alcohol	Chronic alcoholism	Acute alcoholism
Fruits/ Plants	St. John's Wort	Grapefruit

Antiarrythmics	Quinidine
Sterols	Glucocorticois
Antiulcerous		Cimetidine Omeprazole
Antivirals		Ritonavir (HIV protease inhs)
Antitumoral		Cyclosporin

2011-10-24T00:43:00.011-04:00

• Patient presents with ↓ pain and temperature sensation over the lateral aspects of both arms.	What is the lesion?	Syringomyelia.
• Penlight in patient’s right eye produces bilateral pupillary constriction. When moved to	What is the defect?	Atrophy of the left optic nerve.
the left eye, there is paradoxical dilatation.
• Woman involved in a motor vehicle accident cannot turn her head to the left and has right shoulder droop.	What structure is damaged?	Right CN XI (runs through the jugular foramen with CN IX and X), innervating the sternocleidomastoid and trapezius muscles.
• Man presents with 1 wild, flailing arm.	Where is the lesion?	Contralateral subthalamic nucleus (hemiballismus).
• Patient with cortical lesion does not know that he has a disease.	Where is the lesion?	Right parietal lobe.
• Patient’s tongue protrudes toward the left side, and	Where is the lesion?	Left medulla, CN XII.
patient exhibits a right-sided spastic paralysis.
• Patient cannot blink his right eye or seal his lips.	What is the diagnosis, and which nerve is affected?	Bell’s palsy; CN VII.
• Woman presents with headache, visual disturbance, galactorrhea, and amenorrhea.	What is the diagnosis?	Prolactinoma.
• 43-year-old man experiences dizziness and tinnitus. CT	What is the diagnosis?	Schwannoma.
shows an enlarged internal acoustic meatus.
• 25-year-old woman presents with sudden monocular vision	What is the diagnosis?	Multiple sclerosis.
loss and slightly slurred speech. She has a history of weakness and paresthesias that have resolved.
• 10-year-old child “spaces out” in class (e.g., stops talking midsentence and then continues	What is the diagnosis?	Absence seizures.
as if nothing had happened). During spells, the child has a slight quivering of the lips.

• 23-year-old woman crashes her	Which bone and vessel	Middle meningeal artery and
motorcycle. She initially feels	were injured during the	temporal bone, resulting in an
fine, but minutes later she loses	crash?	epidural hematoma.
consciousness. At the ER, a CT shows an intracranial hemorrhage that does not cross suture lines.


• 38-year-old man with a history of Marfan’s syndrome and hypertension presents with a severe headahche. A spinal tap reveals blood in the CSF.	What is the cause of the man’s head pain?	Subarachnoid hemorrhage resulting from a ruptured berry aneurysm


• 78-year-old man with	What structures were	Bridging veins, resulting in
Alzheimer’s disease falls and	damaged by the fall?	subdural hematoma.
presents 3 days later with severe headache and vomiting.

The Muppets: Bohemian Rhapsody

2011-10-19T01:13:00.003-04:00

Some renal Findings

2011-10-17T18:04:00.020-04:00

Multiple myeloma

Ischemic tubular necrosis

Acute pyelonephritis

Hypersensitivity interstitial nephritis

Papillary necrosis & Chronic interstitial nephritis

Aminoglycoside toxicity

Lead nephropathy

Urate nephropathy

Acute Tubular Necrosis (renal azotemia)

Eosinophilic casts (Bence-Jones prot), in tubular lumens

Ischemic tubular necrosis

WBC Casts

Drug-induced interstitial nephritis

NSAID-associated nephropathy

Aminoglycoside toxicity

Chronic tubulointerstitial nephritis

Needle shaped monosodium urate crystals are seen in the interstitium and tubular lumens

Heavy metal poisoning with lead or mercury (produces
Fanconi Sd)

Steve Jobs Inspiring speech

2011-10-14T02:32:00.005-04:00

Steve Jobs - Do Great Work

Steve Jobs on Connecting the Dots, Love & Loss and Doing Great Work

Steve Jobs - Stanford University Commencement Speech Transcript

I am honored to be with you today at your commencement from one of the finest universities in the world. I never graduated from college. Truth be told, this is the closest I've ever gotten to a college graduation. Today I want to tell you three stories from my life. That's it. No big deal. Just three stories.
The first story is about connecting the dots.

I dropped out of Reed College after the first 6 months, but then stayed around as a drop-in for another 18 months or so before I really quit. So why did I drop out?
It started before I was born. My biological mother was a young, unwed college graduate student, and she decided to put me up for adoption. She felt very strongly that I should be adopted by college graduates, so everything was all set for me to be adopted at birth by a lawyer and his wife. Except that when I popped out they decided at the last minute that they really wanted a girl. So my parents, who were on a waiting list, got a call in the middle of the night asking: "We have an unexpected baby boy; do you want him?" They said: "Of course." My biological mother later found out that my mother had never graduated from college and that my father had never graduated from high school. She refused to sign the final adoption papers. She only relented a few months later when my parents promised that I would someday go to college.
And 17 years later I did go to college. But I naively chose a college that was almost as expensive as Stanford, and all of my working-class parents' savings were being spent on my college tuition. After six months, I couldn't see the value in it. I had no idea what I wanted to do with my life and no idea how college was going to help me figure it out. And here I was spending all of the money my parents had saved their entire life. So I decided to drop out and trust that it would all work out OK. It was pretty scary at the time, but looking back it was one of the best decisions I ever made. The minute I dropped out I could stop taking the required classes that didn't interest me, and begin dropping in on the ones that looked interesting.
It wasn't all romantic. I didn't have a dorm room, so I slept on the floor in friends' rooms, I returned coke bottles for the 5¢ deposits to buy food with, and I would walk the 7 miles across town every Sunday night to get one good meal a week at the Hare Krishna temple. I loved it. And much of what I stumbled into by following my curiosity and intuition turned out to be priceless later on. Let me give you one example:
Reed College at that time offered perhaps the best calligraphy instruction in the country. Throughout the campus every poster, every label on every drawer, was beautifully hand calligraphed. Because I had dropped out and didn't have to take the normal classes, I decided to take a calligraphy class to learn how to do this. I learned about serif and san serif typefaces, about varying the amount of space between different letter combinations, about what makes great typography great. It was beautiful, historical, artistically subtle in a way that science can't capture, and I found it fascinating.
None of this had even a hope of any practical application in my life. But ten years later, when we were designing the first Macintosh computer, it all came back to me. And we designed it all into the Mac. It was the first computer with beautiful typography. If I had never dropped in on that single course in college, the Mac would have never had multiple typefaces or proportionally spaced fonts. And since Windows just copied the Mac, it's likely that no personal computer would have them. If I had never dropped out, I would have never dropped in on this calligraphy class, and personal computers might not have the wonderful typography that they do. Of course it was impossible to connect the dots looking forward when I was in college. But it was very, very clear looking backwards ten years later.
Again, you can't connect the dots looking forward; you can only connect them looking backwards. So you have to trust that the dots will somehow connect in your future. You have to trust in something — your gut, destiny, life, karma, whatever. This approach has never let me down, and it has made all the difference in my life.
My second story is about love and loss.
I was lucky — I found what I loved to do early in life. Woz and I started Apple in my parents garage when I was 20. We worked hard, and in 10 years Apple had grown from just the two of us in a garage into a $2 billion company with over 4000 employees. We had just released our finest creation — the Macintosh — a year earlier, and I had just turned 30. And then I got fired. How can you get fired from a company you started? Well, as Apple grew we hired someone who I thought was very talented to run the company with me, and for the first year or so things went well. But then our visions of the future began to diverge and eventually we had a falling out. When we did, our Board of Directors sided with him. So at 30 I was out. And very publicly out. What had been the focus of my entire adult life was gone, and it was devastating.
I really didn't know what to do for a few months. I felt that I had let the previous generation of entrepreneurs down - that I had dropped the baton as it was being passed to me. I met with David Packard and Bob Noyce and tried to apologize for screwing up so badly. I was a very public failure, and I even thought about running away from the valley. But something slowly began to dawn on me — I still loved what I did. The turn of events at Apple had not changed that one bit. I had been rejected, but I was still in love. And so I decided to start over.
I didn't see it then, but it turned out that getting fired from Apple was the best thing that could have ever happened to me. The heaviness of being successful was replaced by the lightness of being a beginner again, less sure about everything. It freed me to enter one of the most creative periods of my life.
During the next five years, I started a company named NeXT, another company named Pixar, and fell in love with an amazing woman who would become my wife. Pixar went on to create the worlds first computer animated feature film, Toy Story, and is now the most successful animation studio in the world. In a remarkable turn of events, Apple bought NeXT, I returned to Apple, and the technology we developed at NeXT is at the heart of Apple's current renaissance. And Laurene and I have a wonderful family together.
I'm pretty sure none of this would have happened if I hadn't been fired from Apple. It was awful tasting medicine, but I guess the patient needed it. Sometimes life hits you in the head with a brick. Don't lose faith. I'm convinced that the only thing that kept me going was that I loved what I did. You've got to find what you love. And that is as true for your work as it is for your lovers. Your work is going to fill a large part of your life, and the only way to be truly satisfied is to do what you believe is great work. And the only way to do great work is to love what you do. If you haven't found it yet, keep looking. Don't settle. As with all matters of the heart, you'll know when you find it. And, like any great relationship, it just gets better and better as the years roll on. So keep looking until you find it. Don't settle.
My third story is about death.
When I was 17, I read a quote that went something like: "If you live each day as if it was your last, someday you'll most certainly be right." It made an impression on me, and since then, for the past 33 years, I have looked in the mirror every morning and asked myself: "If today were the last day of my life, would I want to do what I am about to do today?" And whenever the answer has been "No" for too many days in a row, I know I need to change something.
Remembering that I'll be dead soon is the most important tool I've ever encountered to help me make the big choices in life. Because almost everything — all external expectations, all pride, all fear of embarrassment or failure - these things just fall away in the face of death, leaving only what is truly important. Remembering that you are going to die is the best way I know to avoid the trap of thinking you have something to lose. You are already naked. There is no reason not to follow your heart.
About a year ago I was diagnosed with cancer. I had a scan at 7:30 in the morning, and it clearly showed a tumor on my pancreas. I didn't even know what a pancreas was. The doctors told me this was almost certainly a type of cancer that is incurable, and that I should expect to live no longer than three to six months. My doctor advised me to go home and get my affairs in order, which is doctor's code for prepare to die. It means to try to tell your kids everything you thought you'd have the next 10 years to tell them in just a few months. It means to make sure everything is buttoned up so that it will be as easy as possible for your family. It means to say your goodbyes.
I lived with that diagnosis all day. Later that evening I had a biopsy, where they stuck an endoscope down my throat, through my stomach and into my intestines, put a needle into my pancreas and got a few cells from the tumor. I was sedated, but my wife, who was there, told me that when they viewed the cells under a microscope the doctors started crying because it turned out to be a very rare form of pancreatic cancer that is curable with surgery. I had the surgery and I'm fine now.
This was the closest I've been to facing death, and I hope it's the closest I get for a few more decades. Having lived through it, I can now say this to you with a bit more certainty than when death was a useful but purely intellectual concept:
No one wants to die. Even people who want to go to heaven don't want to die to get there. And yet death is the destination we all share. No one has ever escaped it. And that is as it should be, because Death is very likely the single best invention of Life. It is Life's change agent. It clears out the old to make way for the new. Right now the new is you, but someday not too long from now, you will gradually become the old and be cleared away. Sorry to be so dramatic, but it is quite true.
Your time is limited, so don't waste it living someone else's life. Don't be trapped by dogma — which is living with the results of other people's thinking. Don't let the noise of others' opinions drown out your own inner voice. And most important, have the courage to follow your heart and intuition. They somehow already know what you truly want to become. Everything else is secondary.
When I was young, there was an amazing publication called The Whole Earth Catalog, which was one of the bibles of my generation. It was created by a fellow named Stewart Brand not far from here in Menlo Park, and he brought it to life with his poetic touch. This was in the late 1960's, before personal computers and desktop publishing, so it was all made with typewriters, scissors, and polaroid cameras. It was sort of like Google in paperback form, 35 years before Google came along: it was idealistic, and overflowing with neat tools and great notions.
Stewart and his team put out several issues of The Whole Earth Catalog, and then when it had run its course, they put out a final issue. It was the mid-1970s, and I was your age. On the back cover of their final issue was a photograph of an early morning country road, the kind you might find yourself hitchhiking on if you were so adventurous. Beneath it were the words: "Stay Hungry. Stay Foolish." It was their farewell message as they signed off. Stay Hungry. Stay Foolish. And I have always wished that for myself. And now, as you graduate to begin anew, I wish that for you.
Stay Hungry. Stay Foolish.Thank you all very much.

(Stanford University News)

Basic ECG concepts...(Arrhythmias Big picture)

2011-10-14T01:58:00.006-04:00

Here are some basic concepts about ECG, the most important one, the conduction system of the heart which helps to understand why the arrhythmias of the heart are studied in that order. Begining with everything related to the Sinus Node and Atrium, continuing with the AV node where the conduction is slowed down (that is why the blocks are study here), and then all the main things regarding the ventricles. If you get the big picture of this ECG will become one of the easiest subjects to learn.....

Sarcomere

2011-10-12T00:27:00.006-04:00

Respiratory

2011-10-06T18:35:00.030-04:00

AIRWAY
EXTRATHORACIC (Lips to Glotis)
INTRATHORACIC (Glotis tothe alveoli)

Breath IN
Narrows
Expands

Breath OUT
Expands
Narrows

•Stridor: narrowing in extrathoracic airway (when breath in - INSPIRATION)
Ex: small, jaw, macroglossia (hypothyroidism, Down Sd., storage Dzz), large tonsils, large tonsils, laryngeal webs, laryngeal warts, peritonsil abscess, retropharyngeal abscess, epiglotitis, crup, diphteria.. DO A NECK FILM
•Wheeze: narrowing in intrathoracic airway (when you breath out - EXPIRATION)
It will expected on Obstructive lung dzz ( Asthmatics ) DO A CXR
Never it's a good thing to find wheezing on inspiration → (Bronchospasm, or mass) → sign of more distress pt probably needs to be in ICU
•Rhonchi: air moving over mucus (Obstructive, Productive cough)
•Crackles: collapsed airways “popping”open (All restrictive will have it) (obstructives later on)
–Surfactant is missing
–Alveoli have been scarred down

*DRUGS THAT CAUSE CRACKLES (Pulmonary Fibrosis)BBAT Busulfan, Bleomycin, Amiodarone, Tocainide
* Which patient will more likely have crackles Strep pneumonia or pneumocystis
Bacteria → obstructive (airway)→ Fungus → restrictive (interstitium)
-Strep. pneumonia:bacteria, affects airway, obstrucvitve dzz, ronchi (air moving over mucus)
-Pneumocystis Jirovecchi (fungus), affects intertitium, restrictive dzz, crackles

Aspirin Intoxication

2011-10-04T21:51:00.007-04:00

Aspirin poisoning will produce respiratory alkalosis initially then will produce metabolic acidosis.

Others producing Metabolic acidosis are:

Increased anion Gap (MUD PILES)
M- Methanol
U- Uremia
D- DKA
P- Paraldehyde or phenformin
I- Iron tablets or INH
L- Lactic Acidosis
E- Ethylene glycol
S- Salicilates

Normal anion Gap
Diarrhea
Renal Tubular Acidosis (alkaline urine ph < 5.5)
Hyperchloreima

Insulin Release in Pancreatic β Cell

2011-10-03T14:29:00.021-04:00

DO NOT GIVE THIAZIDES TO HYPERGLYCEMIC, HYPERLIPIDEMIC, & HYPERURICEMIC PATIENS
Remember that normally insulin will inhibit HSL (Hormone Sensitive Lipase) required for the breakdown of stored TG in adipose tissue. Since thiazides stop the production of ATP on the pancreatic β cell, preventing the realease of insulin required for keeping TG inside of adipose tissue, this drugs are not given to hyperlipidemic patients.

Renal Physiology

2011-10-03T14:27:00.002-04:00

Georgia Aquarium, CNN con mis Papis

2011-09-16T23:00:00.000-04:00

World of Coca Cola, Atlanta GA

2011-09-15T22:16:00.002-04:00

Ybor City con el Flaco

2011-09-13T23:42:00.009-04:00

Maine Trip

2011-09-11T15:04:00.006-04:00

There you go!

2011-09-08T17:42:00.002-04:00

There he is .... Quin @ 5 days old of age.......

New nephew Joaquin

2011-09-03T17:32:00.006-04:00

Felicitaciones para Rober y Vale por el nuevo sobrino está precioso.
This is my new nephew Joaquin, congratulations to my brother Rober and my sister-in-law Vale, good job, he is so cute....!
"Quin" welcome to this crazy world....!

Visita Papis, Miami, Spring Hill, Clearwater, Atlanta, Sorrento

2011-08-23T14:20:00.001-04:00

Un cafe para Platon (Ubiergo) by Rober

2011-08-20T09:21:00.003-04:00

My brother Roberto performing Fernando Ubiergo's song "Un Cafe para Platon" unplugged. I'm so proud of him. Muy bien Rober felicitaciones, eso es musica....

Las nenas

2011-08-15T04:05:00.025-04:00

Antiarrhythmics

2011-08-01T03:52:00.017-04:00

Some mnemonics:
Class IC FEP, Class IB LidoMeToca, Class III SIBAD

Also remember:
Beta 1 selective blockers: AMEBA
atenolol
metoprolol
esmolol
betaxolol
acebutalol

Quito - Ecuador

2011-08-01T03:01:00.004-04:00

MURMURS (soplos)

2011-07-29T09:33:00.004-04:00

Hemostasis

2011-07-22T02:35:00.004-04:00

Arachidonic Acid metabolism

2011-07-21T16:28:00.001-04:00

SOME FORMULAS

2011-07-21T15:22:00.022-04:00

• CPP = MAP - IP
(Cerebral Perfusion Pressure) (Mean Arterial Pressure) (Intracraneal Pressure)
• MAP = CO x TPR
(Cardiac Output) (Total Peripheral Resistance)
• CO = HR x SV
(Heart Rate) (Stroke Volume)
• TPR = Viscocity / radius4

Some Respiratory Formulas

• VTotal = VDead Space + VAlveolar

• Vmin = TV x RR

• TV = 10-15 cc/Kg

Example:
• VTotal = VDead Space + VAlveolar
5000 40% ?? = 3000
• Vmin = TV x RR
5000 500 x 10
• TV = 10-15 cc/Kg

PTH DISORDERS & LEUKEMIAS AGE BRACKETS

2011-07-14T18:35:00.005-04:00

CARDIAC CYCLE

2011-07-12T04:27:00.020-04:00

•S3 occurs in early diastole during rapid ventricular filling (after MV opens). Associated with ↑ filling pressures commonly in dilated ventricles. Normal in kids and pregnant♀.
•S4 occurs in late diastole. Associated with ventricular hypertrophy. High atrial pressure (Left atrium must push against stiff LV).

○ Aortic Stenosis → EC (when AV opens)
○ Mitral Prolapse → MC (sudden tensing of chordae tendinae)
○ Mitral Stenosis → OS (tensing of chordae tendinae.
EC= Ejection click, MC= Midsystolic click, OS= Opening snap
Heart Sounds
Auscultation Assistant

Tensor Fascia Lata / Sartorius

2011-07-12T04:13:00.005-04:00

2011-07-12T04:03:00.011-04:00

BLOOD VESSEL INNERVATION

2011-07-11T16:56:00.003-04:00

NICOTINIC RECEPTORS

2011-07-11T16:54:00.003-04:00

BLADDER & LUNGS INNERVATION

2011-07-11T16:53:00.005-04:00

KIDNEY AND PANCREAS INNERVATION (Mnemonic)

2011-07-11T16:49:00.006-04:00

The way Vivi recalls the kidney and pancreas innervation is assigning the number 1 to the organ kidney (because is the #1 arterial pressure regulator organ) and #2 to the pancreas (because type II Diabetes is the most common diabetes ja ja)

Both organs have α and ß receptors

In general α receptors in these two organs decrease and ß receptors increase secretion/release of its hormones.

There you go!

Kidney:
α1 receptors ↓ Renin Release
ß1 receptors ↑ Renin Release

Pancreas:
α2 receptors ↓ Insulin Secretion
ß2 receptors ↑ Insulin Secretion

MUSCARINIC RECEPTORS

2011-07-11T00:50:00.003-04:00

2011-07-11T00:39:00.002-04:00

Reflex Tachycardia & Reflex Bradycardia mediated by:
Stimulation of B1 receptors (Tachy) & M2 receptors (Brady)

B2 receptor blockers contraindications: No in Asthmatics, Diabetics (B1,B2), Spastic Disorders (Prinzmetal Angina, Raynaud Phenomenon)

Sobrinos

2011-06-20T00:36:00.012-04:00

2011-04-21T14:17:00.000-04:00

Cell injury:

- If the oxygen partial pressure (in the plasma) is decreased, the oxygen saturation (on Hb) MUST also decrease.

- Thrombosis in a muscular artery is the most common cause of ischemia.

- Hypoxemia (decrease oxygen partial pressure) is a cause of hypoxia

- Respiratory acidosis ! CO2" ! pO2# ALWAYS (and vice versa).

- Hypoxemic patient that gets 100% oxygen and his pO2 didn’t increase ! shunt ! ventilation defect (ARDS, hyaline membrane disease).

- Perfusion defect (PE) ! "dead space (100% O2 will get the pO2 up)

- Diffusion defect (sarcoidosis, pulmonary edema)

- J reflex innervated by the Kent nerve, cause dyspnea (fluid in lung interstitium irritating the J receptors).

- Anemia (Hb related problem) ! pO2 normal, saturation normal, Hb decreased exertional dyspnea.

- House fire produces tissue hypoxia in 2 ways: CO poisoning (! saturation!, give 100% oxygen) and CN poisoning. Both inhibit cytochrome oxidase.

- Cyanosis is the clinical evidence of decreased saturation. Red pigment hides the cyanosis in CO poisoning (most frequent symptom is headache).

- MetHb ! saturation decreased because the Hb is Fe$ and not Fe% (chocolate color blood) ! 100% oxygen doesn’t improve cyanosis. Treatment is IV methylene blue, vitmamin C (also but not main)

- Sulfa and nitro drugs (oxidizing agent): 1. produce MetHb. 2. Hemolytic anemia, G6PD deficiency.

- MetHb common in HIV, because we use sulfa drugs to treat pneumocystis carinii.

- Right shift curve: 2,3BPG", high altitude, acidosis, fever. Left shift curve: CO, MetHb, HbF, 2,3BPG#, alkalosis.
- Uncoupling agents (mitochondrial membrane permeable to protons): dinitrophenol (wood preserving), alcohol, salicylates. To compensate, NADH, FAD producing systems (which produce protons) increase ! hyperthermia (alcoholics are more susceptible to heatstroke).
- Respiratory acidodis = Hb normal, Saturation#, pO2# Anemia = Hb decrease, saturation normal, pO2 normal CO + MetHb = Hb normal, saturation#, pO2 normal
- Anaerobic glycolysis ! lactate acidosis ! denature proteins + enzymes (can’t even auto digest itself) ! coagulation necrosis ! infarct. Anaerobic glycolysis ! ATP pump malfunction, decrease ATP ! Na enters cells ! water follows ! cellular swelling (reversible!).
- Irreversible cell damage: ATP decrease ! Ca ATPase# ! intracellular Ca" ! activates nuclear enzymes (! pyknosis), phosphlipase (! cell membrane damage) ! pancreatitis.
- Cell death: CK, GOT, GLT, amylase increase.
- Lipofuscin (wear and tear pigment) is a brown pigment in atrophic organs in elderly. It cannot be digested. Hemosiderin or bilirubin can also produce a brown pigment.
- Reperfusion injury (oxygen radicals) can be caused after giving TPA for coronary thrombosis, then oxygenated blood go to the injured cardiac muscle.
- IRDS: retinopathy of prematurity (oxygen radicals destroying the retina, blindness) and bronchopulmonary dysplasia (fibrosis)
- Most common cancer of radiation is Leukemia
- Iron overload cause free radicals ! cirrhosis, restrictive cardiomyopathy, pancreas failure ! malabsorption + diabetes.
- Acetoaminaphen (Tylenol) is the #1 cause of drug induced fulminant hepatitis (damage around central vein). Treatment: N-acetyl cystein ("glutathione)
- Neutralization of superoxide is by superoxide dismutase (turns into peroxide).
- PPP generates Glutathione and NADPH.
- CCL4 can also be converted to a free radial (CCL3) ! fulminant hepatitis.
- Acetoaminaphen (radicals) + Aspirin (#PG) ! kidney damage (renal medulla)
- Di-George syndrome: absence of thymus, cause tetany.
- Councilman body in Hepatitis: apoptotic eosinophilic cell with no nucleus.
- Coagulation necrosis - Pale infarct: Heart, kidney, spleen, liver Hemorrhagic infarct: Bowel, testicle (torsion), lungs.
- Vegetation of acute rheumatic fever rarely embolize. Infective endocarditis does.
- Mitral stenosis can cause thrombi in left atrium ! atrial fibrillation.
- The arrhythmia most associated with systemic emboli is atrial fibrillation.
- Dry gangrene: no pus
- Most common cause of non traumatic amputation is diabetes ("ATH of popliteal artery)
- Most common cause of bowel infarction: #1: adhesions of previous surgery, #2: piece of small bowel trapped in an indirect inguinal hernia.
- Liquefactive necrosis is related to an infection where neutrophils are involved (acute inflammation, lung/brain abscess, cellulites by strep.) and also related to brain infarct.
- Granulmatose necrosis: caseous – mycobacteria or systemic fungal infection.
Non caseous – sarcoidosis.
- Epigastric distress with pain radiating to the back ! pancreatitis (retroperitoneal)
- Enzymatic fat necrosis (pancreas) or traumatic fat necrosis (breast, adipose) can both calcify (look like cancer on X-ray) but it’s painful unlike cancer.
- Calcium bound to fatty acid = saponification (chalky white areas on X-ray).
- Bluish discoloration on histologic sections is calcium (dystrophic calcification).
- Fibrinoid necrosis (looks like fibrin but isn’t): immunological diseases (rhematic fever, rheumatic arthritis, glomerulonephritis, SLE, vasculitis).
- Palpable purpura: small vessel vasculitis, hypersensitivity type 3.
Conditions that present with palpable purpura include: Henoch-Schönlein purpura, subacute bacterial endocarditis and Rocky Mountain spotted fever.
- Immune complex ! activate alternative complement system ! C5a ! chemotaxis of neutrophils that cause the actual damage.
- Yellow fever (Arbovirus) damages the liver zone 2 (mid-zone necrosis)
- Alcoholics have fasting hypoglycemia, lactic acidosis ("NADH shift pyruvate to lactate so there is no substrate for GNG), keto-acidosis (& hydroxybutyrate).
- Restriciting CH will reduce the synthesis of VLDL (Glycolysis provides glycerol 3 phosphate, which is the backbone of TAG which is incorporated into VLDL).
- Kwashiorkor: reduce protein intake ! no apo-proteins ! huge fatty liver
Reduce protein intake ! no oncotic pressure ! Ascites.
- Ferritin (soluble iron storage) is a marker for diagnosing iron deficiency anemia or hemosiderosis, hemochromatosis.
Hemosiderin (insoluble iron storage), stored in MP and BM. Stained with Prussian blue.
- Dystrophic calcification: damaged tissue gets calcified (fat necrosis, ATH, aortic stenosis, hemolytic anemia), normal serum calcium.
Metastatic calcification: hypercalcemia or hyperphosphatemia ! calcium deposits in normal tissue.
- Congenital bicuspid aortic valve is the most common cause of aortic stenosis.
- Spectrin is needed to keep a bi-concave disc, if it’s defective ! spherocytosis.
- Ubiquination - Mallory bodies = alcoholic hepatitis
Neurofibrillaty tangles (tau protein) = Alzheimer, Creutzfeldt-Jakov disease.
Lewy body = Parkinson (substantia nigra, dopamine)
- Labile cells = division is via stem cells (BM, skin, intestinal crypts), in cell cycle.
Cell cycle specific or non specific drugs ! BM suppression, diarrhea, rash.
- Stable cells = mostly in G0, but can be stimulated to divide (liver, spleen, kidney, smooth muscle, endometrium)
- Permanent cells = can’t get into the cell cycle (striated and cardiac muscles, neurons), can go through hypertrophy.
- Hyperplasia = increase in number, hypertrophy = increase in size.
- The length of the cell cycle is decided by the length of the G1 stage.
- Glucagon is a phosphorylator, insulin is a dephosphorylator.
- Rb (chr.13) prevents the cell from going into S phase.
When phosphorylated by CDK, it’s inactive. p53 (chr.19) induces a CDK inhibitor, gives time to detect & correct defects before entry to S phase.
- HPV E6 suppresses p53, HPV E8 suppresses Rb.
- No Rb protein ! Retinoblastoma, osteogenic sarcoma, breast cancer.
- Codman’s triangle seen in: osteosarcoma, Ewing sarcoma, subperiosteal abscess.
- Vinca Alkaloids (periwinkle plant), Paclitaxel (chemotherapy, yew tree),
Colchicine, Griseofulvin ! M phase
Etoposide ! G2 phase
MTX, Bleomycin ! S phase
- MTX, used in rheumatoid arthritis, inhibits DHF reductase ! can cause macrocytic anemia.
- Atrophy = decrease in tissue mass, decrease cell size, less mitochondria.
- Hydronephrosis is mostly caused by renal stones ! increase pressure ! ischemia ! atrophy of renal tubules.
- ATH, Alzheimer (& amyloid protein, layers 3,5,6 destroyed), ALS ! brain atrophy, neuron degeneration.
- Hypopituitarism ! adrenal gland atrophy (zona reticularis and fasiculata ONLY)
- Oral thyroid ! thyroid atrophy.
- CF (Chr.7) ! block lumen ! pancreas atrophy
- Renal vascular hypertension ! kidney atrophy, other kidney hypertrophy ("renin)
- If you block G2 phase, you have 4n chromosomes (no mitosis)
- Hyperplasia left unchecked is predisposing for cancer (EXCEPT prostate)
- Unopposed estrogen (no progesterone) causes endometrial hyperplasia ! atypical hyperplasia ! cancer.
- Gravid uterus (after delivery): 50% hypertrophy, 50% hyperplasia.
- RBC hyperplasia in BM may be caused by COPD
- Erythropoetin is made in the endothelial cells of the peri-tubular capillary.
- Psoriasis is an unregulated proliferation of squamus cells in the skin (hyperplasia).
Treatment: MTX (works on the basal cells).
- All hormone stimulated glands go through hyperplasia, not hypertrophy.
- Urinary bladder goes through hypertrophy of smooth muscle cells related to afterload caused by urethra narrowing.
- H. Pylori is the most common cause of adenocarcinoma of the stomach.
- Clonorchis Sinensis (Chinese liver fluke) is associated with cholangiocarcinoma
Schistosome Haematubium causes squamus metaplasia (instead of transitional) in the urinary bladder ! SCC.
- Dysplasia = atypical hyperplasia, precursor for cancer.
- Actinic (solar) keratosis is premalignant to SCC of the skin, related to chronic sun exposure and excess keratin. If scraped off, it grows back.
- No premalignant lesion to basal cell carcinoma. It is more common.

2011-04-20T01:02:00.000-04:00

Cell injury:

- If the oxygen partial pressure (inthe plasma) is decreased, the oxygen saturation (on

Hb)MUST also decrease.

- Thrombosis in a muscular artery isthe most common cause of ischemia.

- Hypoxemia (decrease oxygen partial pressure) is acause of hypoxia

- Respiratory acidosis ! CO2" ! pO2# ALWAYS (and viceversa).

- Hypoxemic patient that gets 100%oxygen and his pO2 didn’t increase ! shunt !

ventilationdefect (ARDS, hyaline membrane disease).

- Perfusion defect (PE) ! "dead space (100% O2 will get the pO2 up)

- Diffusion defect (sarcoidosis,pulmonary edema)

- J reflex innervated by the Kent nerve, cause dyspnea(fluid in lung interstitium irritating

theJ receptors).

- Anemia (Hb related problem) ! pO2 normal, saturation normal, Hb decreased !

exertionaldyspnea.

- House fire produces tissue hypoxia in2 ways: CO poisoning (! saturation!, give

100%oxygen) and CN poisoning. Both inhibit cytochrome oxidase.

- Cyanosis is the clinical evidence of decreasedsaturation. Red pigment hides the

cyanosisin CO poisoning (mostfrequent symptom is headache).

- MetHb ! saturation decreased because the Hb is Fe$ and not Fe% (chocolate color

blood)! 100% oxygen doesn’t improve cyanosis. Treatment is IV methylene blue,

vitmaminC (also but not main)

- Sulfa and nitro drugs (oxidizing agent): 1. produce MetHb. 2. Hemolytic anemia, G6PD

deficiency.

- MetHb commonin HIV, because we use sulfa drugs to treatpneumocystis carinii.

- Right shift curve: 2,3BPG", high altitude, acidosis, fever.

Left shift curve: CO,MetHb, HbF, 2,3BPG#, alkalosis.

- Uncoupling agents (mitochondrial membrane permeable to protons): dinitrophenol

(woodpreserving), alcohol, salicylates. To compensate, NADH, FAD producing

systems(which produce protons) increase ! hyperthermia(alcoholics are more

susceptibleto heatstroke).

- Respiratory acidodis = Hb normal, Saturation#, pO2#

Anemia = Hb decrease, saturation normal, pO2normal

CO + MetHb = Hb normal,saturation#, pO2 normal

- Anaerobic glycolysis ! lactate acidosis ! denature proteins +enzymes (can’t even

autodigest itself) ! coagulation necrosis ! infarct.

Anaerobicglycolysis ! ATP pump malfunction, decrease ATP! Na enters cells !

waterfollows ! cellular swelling (reversible!).

- Irreversible cell damage: ATPdecrease ! Ca ATPase# ! intracellular Ca" !

activatesnuclear enzymes (! pyknosis), phosphlipase (! cell membrane damage)

! pancreatitis.

- Cell death: CK, GOT, GLT, amylaseincrease.

- Lipofuscin (wear and tear pigment) is a brown pigmentin atrophic organs in elderly. It

cannotbe digested. Hemosiderin or bilirubin can also produce a brown pigment.

- Reperfusion injury (oxygen radicals)can be caused after giving TPA for coronary

thrombosis,then oxygenated blood go to the injured cardiac muscle.

- IRDS: retinopathy of prematurity(oxygen radicals destroying the retina, blindness) and

bronchopulmonarydysplasia (fibrosis)

- Most common cancer of radiation is Leukemia

- Iron overload cause free radicals ! cirrhosis,restrictive cardiomyopathy, pancreas

failure! malabsorption + diabetes.

- Acetoaminaphen (Tylenol) is the #1 cause of drug induced fulminant hepatitis

(damagearound central vein). Treatment: N-acetyl cystein ("glutathione)

- Neutralization of superoxide is bysuperoxide dismutase (turns into peroxide).

- PPP generates Glutathione and NADPH.

- CCL4 canalso be converted to a free radial (CCL3) ! fulminant hepatitis.

- Acetoaminaphen (radicals) + Aspirin (#PG) ! kidney damage (renal medulla)

- Di-george syndrome: absence of thymus, cause tetany.

- Councilman body in Hepatitis: apoptotic eosinophilic cell with no nucleus.

- Coagulation necrosis - Pale infarct: Heart, kidney,spleen, liver

Hemorrhagic infarct: Bowel,testicle (torsion), lungs.

- Vegetation of acute rheumatic fever rarely embolize. Infectiveendocarditis does.

- Mitral stenosis can cause thrombi in left atrium ! atrialfibrillation.

- The arrhythmia most associated with systemic emboli is atrial fibrillation.

- Dry gangrene: no pus

- Most common cause of non traumaticamputation is diabetes ("ATH of popliteal

artery)

- Most common cause of bowel infarction: #1: adhesions of previous surgery,

#2:piece of small bowel trapped in an indirect inguinal hernia.

- Liquefactive necrosis is related to an infection whereneutrophils are involved (acute

inflammation,lung/brain abscess, cellulites by strep.) and also related to brain infarct.

- Granulmatose necrosis: caseous – mycobacteria or systemic fungal infection.

Non caseous – sarcoidosis.

- Epigastric distress with pain radiating to the back ! pancreatitis (retroperitoneal)

- Enzymatic fat necrosis (pancreas) or traumatic fat necrosis (breast,adipose) can

bothcalcify (look like cancer on X-ray) but it’s painfulunlike cancer.

- Calcium bound to fatty acid =saponification (chalky white areas on X-ray).

- Bluish discoloration on histologic sections is calcium (dystrophiccalcification).

- Fibrinoid necrosis (looks like fibrin but isn’t): immunologicaldiseases (rhematic fever,

rheumaticarthritis, glomerulonephritis, SLE, vasculitis).

- Palpable purpura: small vessel vasculitis, hypersensitivity type 3.

Conditionsthat present with palpable purpura include: Henoch-Schönleinpurpura,

subacutebacterial endocarditis and RockyMountain spotted fever.

- Immune complex ! activate alternative complement system ! C5a ! chemotaxis of

neutrophilsthat cause the actual damage.

- Yellow fever (Arbovirus) damages the liver zone 2(mid-zone necrosis)

- Alcoholics have fasting hypoglycemia, lactic acidosis ("NADH shift pyruvate to lactate

sothere is no substrate for GNG), keto-acidosis(& hydroxybutyrate).

- Restriciting CH will reduce thesynthesis of VLDL (Glycolysis provides glycerol 3

phosphate,which is the backbone of TAG which is incorporated into VLDL).

- Kwashiorkor: reduce protein intake ! no apo-proteins ! huge fatty liver

Reduceprotein intake ! no oncotic pressure ! Ascites.

- Ferritin (soluble iron storage) is a marker for diagnosing iron deficiencyanemia or

hemosiderosis,hemochromatosis.

Hemosiderin(insoluble iron storage), stored in MP and BM. Stainedwith Prussian

blue.

- Dystrophic calcification: damaged tissue gets calcified (fatnecrosis, ATH, aortic

stenosis,hemolytic anemia), normal serum calcium.

Metastatic calcification: hypercalcemia or hyperphosphatemia !calcium deposits in

normal tissue.

- Congenital bicuspid aortic valve is the most common cause of aorticstenosis.

- Spectrin is needed to keep a bi-concave disc, if it’s defective ! spherocytosis.

- Ubiquination - Mallory bodies = alcoholic hepatitis

Neurofibrillatytangles (tau protein) = Alzheimer, Creutzfeldt-Jakov disease.

Lewybody = Parkinson (substantia nigra, dopamine)

- Labile cells = division is via stem cells (BM, skin,intestinal crypts), in cell cycle.

Cellcycle specific or non specific drugs ! BMsuppression, diarrhea, rash.

- Stable cells = mostly in G0, but can be stimulated to divide (liver, spleen, kidney,

smoothmuscle, endometrium)

- Permanent cells = can’t get into the cell cycle (striatedand cardiac muscles, neurons),

can go through hypertrophy.

- Hyperplasia = increase in number, hypertrophy = increase in size.

- The length of the cell cycle isdecided by the length of the G1 stage.

- Glucagon is a phosphorylator, insulin is a dephosphorylator.

- Rb (chr.13) prevents the cell from going into S phase.

Whenphosphorylated by CDK, it’s inactive.

p53 (chr.19) induces a CDK inhibitor, givestime to detect & correct defects before

entryto S phase.

- HPV E6 suppresses p53, HPV E8suppresses Rb.

- No Rb protein ! Retinoblastoma, osteogenic sarcoma, breast cancer.

- Codman’s triangle seen in: osteosarcoma, Ewing sarcoma,subperiosteal abscess.

- Vinca Alkaloids (periwinkle plant), Paclitaxel (chemotherapy, yew tree), Colchicine,

Griseofulvin! M phase

Etoposide! G2 phase

MTX,Bleomycin ! Sphase

- MTX, used in rheumatoid arthritis,inhibits DHF reductase ! can cause macrocytic

anemia.

- Atrophy =decrease in tissue mass, decrease cell size, less mitochondria.

- Hydronephrosis is mostly caused by renal stones ! increase pressure ! ischemia !

atrophyof renal tubules.

- ATH, Alzheimer (& amyloid protein, layers 3,5,6destroyed), ALS ! brain atrophy,

neurondegeneration.

- Hypopituitarism ! adrenal gland atrophy (zona reticularis and fasiculata ONLY)

- Oral thyroid ! thyroid atrophy.

- CF (Chr.7) !block lumen ! pancreas atrophy

- Renal vascular hypertension ! kidney atrophy, other kidney hypertrophy ("renin)

- If you block G2 phase, you have 4n chromosomes (no mitosis)

- Hyperplasia left unchecked ispredisposing for cancer (EXCEPT prostate)

- Unopposed estrogen (no progesterone) causes endometrialhyperplasia ! atypical

hyperplasia! cancer.

- Gravid uterus (after delivery): 50% hypertrophy, 50% hyperplasia.

- RBC hyperplasia in BM may be caused by COPD

- Erythropoetin is made in the endothelial cells of the peri-tubular capillary.

- Psoriasis is an unregulated proliferation of squamus cells in the skin (hyperplasia).

Treatment:MTX (works on the basal cells).

- All hormonestimulated glands go through hyperplasia, nothypertrophy.

- Urinary bladder goes through hypertrophy of smooth muscle cells related to afterload

causedby urethra narrowing.

- H. Pylori is the most common cause of adenocarcinomaof the stomach.

- Clonorchis Sinensis (Chinese liver fluke) is associated with cholangiocarcinoma

SchistosomeHaematubium causes squamus metaplasia (instead oftransitional) in the

urinarybladder ! SCC.

- Dysplasia = atypical hyperplasia, precursor for cancer.

- Actinic (solar) keratosis is premalignant to SCC of the skin, related to chronic sun

exposureand excess keratin. If scraped off, it grows back.

- No premalignant lesion to basal cell carcinoma. It ismore common.

SARCOIDOSIS

2010-11-18T18:13:00.003-05:00

Nice picture summarizing signs and symptoms of sarcoidosis
source:nhlbi.nih.gov

Craniopharyngioma

2010-11-18T18:05:00.005-05:00

MRI in lateral view. Large cystic craniopharyngioma in an adult with severe hormonal deficiency, drowsiness and visual deficit. The yellow arrow points to the small solid part, the red to the large cyst.
Remember Craniopharyngiomas typically have 3 components SOLID, CYSTIC, and CALCIFIED

source: Neurochirurgia

Menstrual Cycle

2010-11-04T20:07:00.011-04:00

>Female reproductive system
Hormonal changes

Renin angiotensin-aldosterone system

2010-11-04T19:00:00.004-04:00

Brain Hernation

2010-11-04T18:26:00.010-04:00

Brain Hernation: "Brain Herniation"
(Cranial nerve III)